Q&A: ICD 10 and infusion nurses

On October 1, 2015, one of the biggest events that hit healthcare data in decades was the conversion of coded clinical data to the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision, commonly referred to as ICD-10.

Q: What happened to ICD 9?

A:In 1983, Medicare implemented ICD-9 as part of the Inpatient Prospective Payment System (IPPS). Since that time, healthcare has advanced significantly and ICD-9 codes no longer represent the advances and complexities in care provided to patients. ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after October 1, 2015.

Q: What is the new ICD 10?

A:  ICD-10 is a provision of HIPAA, as regulated by the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). This federal mandate pertains to all HIPAA-covered entities. The new ICD 10 consist of more than 69,000 new codes. There are two parts to ICD-10: ICD-10-Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS). The intent is to streamline clinical communication by implementing new and more detailed 7-digit alphanumeric codes.The transition from ICD-9 to ICD-10 is occurring for the following reasons:

  • ICD-9 codes have limited data about the patient’s medical conditions and hospital inpatient procedures.
  • ICD-9 codes use outdated and obsolete terms and are not consistent with current medical practices.

Q: Will ICD 10 change the CPT (current procedural terminology) codes we currently use for outpatient infusions?

A: The transition to ICD-10 does not affect CPT coding for outpatient procedures. For hospital inpatient procedures, ICD-9 codes will be transitioned to ICD-10-PCS (Procedure Coding System).

Q: Who is required to convert to ICD 10 codes?

A: Everyone covered by HIPAA must convert to ICD-10. This includes providers and payers who do not deal with Medicare or Medicaid claims. For HIPAA-covered entities, transition to ICD-10 is not an option. Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedure codes. This change does not apply to Current Procedural Terminology (CPT) coding for outpatient procedures. Without ICD-10, providers will experience delayed payments or even non-payments; increased rejected, denied or pending claims; reduced cash flows and ultimately lost revenues.

Q: If outpatient infusion services using CPT codes are not affected, why should infusion nurses care about ICD 10?

A: The “diagnosis” for which the infusion service is indicated requires the  new ICD 10 diagnosis code. In an infusion setting, many other processes involve a diagnosis code. Examples are but not limited to: referral source forms, intake forms, billing forms, claims submissions, payer authorizations, drug reports and databases, and documentation by other providers (physicians, pharmacists,dietitians and home health nursing agencies). The proper ICD 10 diagnosis code is important not only for accurate documentation and reporting to improve patient care and outcomes but for billing and getting paid for services rendered. Without ICD-10, providers will experience delayed payments or even non-payments; increased rejected, denied or pending claims; reduced cash flows and ultimately lost revenues.<- we all know what this means!!

Here’s an example of an old ICD 9 code and the new ICD 10 code for Rheumatoid Arthritis.

ICD10-RASource: JanssenAccessOne 

For more information about ICD 10, check out these resources:

  1. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf
  2. http://www.cms.gov/icd10
  3. https://www.cms.gov/eHealth/downloads/eHealthU_SmallMedPracChecklist.pdf